NHS chief explains NPfIT delays

The chief executive of the National Health Service has told MPs that complexity and customisation have been the main causes in delaying England's National Programme for IT.

David Nicholson was speaking to Parliament's Public Accounts Committee at its hearings on the programme on 16 June 2008.

Committee chair Edward Leigh MP highlighted the delays in key elements of the programme, notably the delivery of patient administration systems to hospitals and the development of the Care Record Summary, and asked why this had occurred.

In response, Nicholson said that three factors have undermined the delivery of the programme. One was a preoccupation with creating public confidence by piloting systems, subjecting them to independent evaluation and making sure the public will use them.

Another was that the programme was "incredibly ambitious technically", and that suppliers have found it difficult to deliver products that work. The third was that there has been a heavy degree of customisation to meet the demands of individual trusts.

"We are trying hard to work with organisations to see what they need," Nicholson said. "The customisation has been more extreme than we envisaged at the beginning of the programme."

When Leigh asked why the MPs should have more confidence in the new time scales, which forecast NPfIT's implementation by 2012, Nicholson responded that Connecting for Health (CfH), the agency in charge, is now more experienced and coordinated. It is working better with the two remaining local service providers, CSC and BT, and believes that work on the Lorenzo and Cerner Millenium software products is now showing results.

Leigh pointed out that hospital trusts have the right to use other systems if they wish and asked what potential liabilities the NHS faces if they do so. Nicholson said he thought the trusts would choose the NPfIT systems, and that none had made a viable long term business case for an alternative. He cited the case of Bradford Teaching Hospitals NHS Foundation Trust, which had considered alternatives but decided against them, and claimed that Newcastle Hospitals Trust has only chosen another system as an interim measure.

He also resisted a suggestion from Alan Williams MP that the software suppliers had breached their obligations and should be dropped from the programme. Nicholson argued that that there had been over 130 deployments of patient administration systems around England, although most had been in mental health and primary care trusts and only 30 in hospital trusts.

"It would be ludicrous at the moment to drop them when we are close to doing what we have been trying to do for several years," he said.

The MPs also took a close interest in the events leading up to the recent termination of Fujistu's contract as local service provider for the southern region. The company's public services managing director Peter Hutchinson said: "The project was not run the way the company originally envisaged. We worked together hard to find a way forward and felt we were close to it, but in the end we couldn't agree on a price."

He said a major problem had been that trusts had wanted a series of changes - totalling 650 for the region - in the patient administration systems before signing off on the delivery. This had amounted to a case of "contract creep" which had undermined the company's financial case for the programme.

Gordon Hextall, the NHS's interim director of IT programmes, told the committee that no decision had yet been made about a replacement for Fujitsu in the southern region. There has been speculation that BT would take over the region, largely because it is also using the Cerner Millenium system in its London cluster, but Hextall said southern trusts could also possibly choose the Lorenzo software being developed for the north, east and Midlands, which are under CSC.